卫生服务研究的设计、衡量与评价

卫生服务研究(HSR)涉及卫生服务的实施与效果。它包括以下几部分:1.研究卫生需要、要求和利用;2.评价服务的效果和公平程度;3.对各种服务方式(如医院服务与社区服务)进行试验研究;4.对卫生资源(人力、物力、财力等)以及组织实施机构的研究;5.开展卫生服务的随机对照试验研究等。(Cohen,1981)。     

经济收入和医疗保健制度对卫生服务公平性的影响

文章应用“利用/需要比“(Le Grand法)对南通和淄博两市职工家庭卫生服务利用的公平性进行分析发现,家庭经济收入对卫生服务公平性影响不大,不同医疗保健制度人群间存在不公平性,自费医疗限制了卫生服务利用,且与宏观经济状况和卫生服务体系改革有密切的关系.建议完善卫生服务体制改革,关注城市自费人群的卫生服务利用,提高卫生服务公平性.     

乡镇工业职业卫生服务需求量的调查

本文对三个县(市)乡镇工业企业职业卫生服务需求量进行了调查,结合目前县(市)级劳动卫生机构的实际职业卫生服务能力,探讨了影响乡镇工业职业卫生服务需求量及满足程度的因素。提出了进一步有效地开展乡镇工业职业卫生服务的对策。     

农村社区老年人精神卫生服务需求与利用情况调查分析

目的:了解农村社区老年人的精神障碍患病率,掌握农村社区老年人精神卫生服务利用和需求情况.方法:在既往队列研究基础上,使用老年精神状况量表GMS(Geriatric Mental Scales)确定该队列人群精神障碍水平,使用自拟问卷测量精神卫生服务需求与利用情况.使用x2检验或Fisher确切概率法进行单因素分析.结果:①该研究实际随访到914名老年人,诊断有精神障碍的146(15.97％)人.②914人中仅有6人使用过精神卫生服务,146人中仅有2人使用过精神卫生服务.③191人(20.9％)表示需要进一步了解精神卫生服务知识.影响知识需求的因素有文化程度、自评经济、躯体疾病和心理障碍.④56人(6.1％)表示需要精神卫生服务.影响精神卫生服务的因素有性别、文化程度和心理健康水平.结论:农村社区老年人精神卫生服务使用率较低,自我心理保健意识较差.政府应加大精神卫生宣教的投入,提高社区老人对心理健康重要性的认识.     

四川省部分贫困地区乡(镇)卫生院基本卫生服务能力现况调查

[目的]了解四川省部分贫困地区在接受卫生项目资助之后乡(镇)卫生院基本卫生服务开展情况,总结经验与不足,为改善贫困地区乡(镇)卫生院提供基本卫生服务的能力,提高居民健康水平提供科学参考.[方法]在某贫困县分层随机抽取3个乡(镇),利用自行设计的问卷对其乡(镇)卫生院进行机构调查;并分层随机抽取87名普通村民进行问卷调查.[结果]各乡镇卫生院的基本设施齐全,开展的基本卫生服务基本能满足居民的需要,但还存在一定的问题.[结论]为改善贫困地区居民健康水平,建议增加对乡镇卫生院的投入,保障基本设施的建设;加强乡镇卫生院卫生技术队伍的建设,保证卫生服务的质量;加强对卫生服务各领域的重视,提高卫生服务能力.     

论基层卫生监督工作网上路径探讨

基层卫生监督工作,网上路径探讨是本次探讨的重点,笔者从实际工作出发,从3个方面对网上路径进行了论述,(1)从服务对象网上路径；(2)从执法人员网上路径；(3)从领导机关网上路径；笔者通过探讨认为卫生监督网上路径需要多方配合,多方支持和协助才能更好完成任务.在各个路径上工作上的同志目的只有一个,让服务对象满意,让服务型政府展示形象,让卫生监督执法服务社会群众更加规范、科学合理.卫生监督提倡“监督就是服务,在服务中监督法”理念,是当今社会和政府的要求,基层卫生监督单位创新网上路径,目标就是为了让广大群众办事更加方便、快捷,体现服务政府让群众更满意.     

我国现阶段卫生筹资政策分析

介绍中国卫生筹资政策的背景，对中国现阶段卫生筹资政策进行分析，提出进行卫生筹资改革的建议：(1)增加政府卫生投入；(2)卫生服务重点转向预防保健；(3)卫生筹资政策更多地倾向贫困人口及脆弱人群；(4)大力发展社区卫生服务，并将社区卫生服务纳入医保；(5)实行同行服务审核制度；(6)积极推行医院预付制。     

某部2012年餐饮食品安全状况分析

为了加强对某部餐饮服务食品安全的监督管理,保障就餐人员的身体健康,预防食物中毒的发生,我们于2012年对某部餐饮服务单位食品安全卫生状况进行了检查,现将结果报告如下. 1 对象和方法 (1)对象:以某部90个餐饮服务单位为检查对象,其中招待机构餐饮部37个,内部食堂53个.(2)方法:采取现场检查、采样检测相结合的方法,由卫生监督员按照统一的操作评价标准具体实施.现场检查主要包括卫生管理、建筑布局、原料采购与贮存卫生、环境卫生和设施、加工过程卫生、冷荤间特殊要求.采样检测中,餐具依据GB 14934-1994《食(饮)具消毒卫生标准》进行采样检测,其它食品依据相关国家标准进行采样检测.     

中国加入世界贸易组织对医疗卫生的影响

中国加入世界贸易组织(WTO)对卫生事业改革与发展有重大影响.本文介绍了WTO有关协定与医疗卫生直接相关的有关协定,我国关于"开放卫生服务部门"的承诺,描述了我国开放卫生服务部门的政策与现状,分析了入世对疾病预防控制、卫生监督、医疗服务、中医中药、卫生行政管理的影响、机遇、挑战与对策.     

安徽省卫生资源配置的公平性分析

卫生服务涉及人的最基本生存权,保证社会成员得到公平有效的卫生服务是政府在卫生领域追求的重要目标之一,也是医疗卫生制度改革的重点.卫生资源配置的公平性是卫生服务公平性的重要内容,是实现卫生利用公平和公众健康权益公平的基础条件之一,关系到卫生事业的健康发展.本文利用2008年安徽省17个市卫生设施(机构、病床)与卫生人力资源(医生和护士)配置方面的数据资料,借鉴基尼系数方法,从人口和地理两个角度对卫生资源的配置公平性进行分析,为进一步实施区域卫生规划、促进卫生行业的发展提供科学依据.     

Facing the cuts: a health authority's experience of rate-capping.

Health and social services in Britain are both publicly funded, but health care is provided centrally by the National Health Service while social services are provided by local government. Central government has sought to limit overall public spending by limiting the income of local authorities from rates (property taxes)--a policy known as rate-capping. In the face of this policy, one inner London local authority was forced to cut its social services budget in 1988/89 by 17%. We have compared the actual social service reductions with the perceptions, expressed in semi-structured interviews, of 69 health and social services staff. There was a perceived deterioration in social service provision, and indicators were suggested which would help health service staff to monitor these changes. There were also recent and more long-standing difficulties of communication between the two services, which limited joint working. The increasing emphasis on community care requires health authorities to cooperate more closely with social services at the local level.     

德国等九个发达国家区域卫生规划的经验与启示

德国、英国等9个发达国家的经验表明,对医疗服务能力进行区域卫生规划,以提高资源配置效率、满足多层次医疗服务需求、控制医疗费用的膨胀,是国际通行的做法;规划一般由中央政府制定原则,由区域政府（州／省）参与并负责执行;以社会医疗保险为主的国家侧重全社会的服务能力规划,而以国民卫生服务为主体的国家则侧重对公立医疗卫生体系的规划。这些经验对我国在新一轮“医改”中进一步推动区域卫生规划具有重要借鉴意义。     

HMOs in the U.S.A. and Britain: a new prospect for health care?

Health Maintenance Organisations (HMO) are poised to become the mainstream form of health care delivery in the U.S.A. by the end of the next decade. This article charts their progress and the expectations held for them in both the U.S.A. and Britain. It is argued that HMOs are undergoing corporatization in the U.S.A., while in the U.K. they are being considered chiefly as instruments of privatisation and as a method for introducing managerial authority into the medical profession. The claims of advocates of HMOs, in terms of their competitive effects, reduced costs and enhanced quality of service, are reviewed. Although no HMOs exist in Britain, they have found support in influential quarters. The proposals and claims of the advocates of HMOs in Britain are reviewed. Although HMOs have not yet found favour with the current government, it is argued that the concept will continue to receive support and may become a component of health policy in the near future.     

Reducing inequalities in health: political and organisational implications for the British National Health Service

Tackling health inequalities with any hope of success requires an understanding and appreciation of a number of issues concerning the nature and operation of services. Focussing on the British experience, the paper considers notions of need and demand insofar as these have a bearing on health inequalities. Need and demand are not finite, absolute states but are relative notions which are affected by users' attitudes and knowledge and by providers' preferences and interests. Drawing upon recent work, the paper argues that the existence of the National Health Service (NHS) has not fundamentally altered the nature of health inequalities in Britain. Those living in the North of the country generally enjoy poorer health than those living in the South. Inequalities between socio-economic groups are also much in evidence. The paper considers possible policy implications and comes out in favour of process change rather than major structural change of the kind witnessed in recent years in Britain where the NHS has undergone two major upheavals within a decade. This disruption has had the effect of diverting attention away from important policy issues at all levels of service planning and provision.(ABSTRACT TRUNCATED AT 250 WORDS)     

公众参与医疗服务质量改进：国际经验和中国展望

目的探讨公众参与卫生服务质量管理的国际经验和中国发展前景。方法文献学习。结果公众参与卫生服务质量管理具有卫生服务民主化的政治意义，同时也是优化卫生服务管理、提高服务绩效和质量的途径之一。公众参与需要得到政府支持、消费者组织的影响力和资源、卫生行政管理的系统改革、对公众声音采取积极响应的承诺；公众参与的挑战来自政府决策证据和医学阶层及自律属性。同时公众界定、代表产生、参与方式等也是实际中面临的问题。公众参与的利益相关者互动过程和结果评价，是决定是否成功的因素。结论中国的公众参与还处于初级阶段，除依靠公民社会发展条件外，还需要完善适合中国特色的公众参与的科学证据。     

Primary healthcare for people with mental health problems or learning disabilities

The physical health inequalities experienced by people with mental health problems or learning disabilities are well established, though comprehensive data for England and Wales have not previously been available. Nor have the reasons for inequalities been examined in detail. The Disability Rights Commission in Great Britain set out to examine such inequalities in relation to primary healthcare and to establish what remedial actions are needed. A range of data-gathering mechanisms was used, including clinical data analysis, qualitative research, structured feedback from service users and professionals, and a high-level inquiry panel which took evidence from government departments and agencies and from national organisations. The data provide detailed evidence about inequalities and this paper sets out key recommendations for change.     

Community participation and health care priorities: reflections on policy, theatre and reality in Britain

In recent years, the British government has attempted to make the finite nature of publicly funded health care explicit and to involve the 'public' in discussions about which treatments (or indeed patients) should be given priority over others. This article considers the nature of the new political emphasis upon local participation through analysis of policy and illustrative reference to a system of participatory forums in the field of mental health planning developed in an area of southern England. The tendency by the health authority in question not to respond to many of the issues raised by the forums illustrates two characteristics of the health service in Britain. Firstly, there continues to exist a political , managerial and clinical hegemony within the service such that health authorities tend not to have to account for the weight they attach to local views or the manner in which such preferences are measured against other imperatives and considerations. In a second respect, the simplistic notion of the 'purchase' of health care by health authorities on behalf of local populations is problematic. Health authorities are faced with a panoply of political, statutory and bureaucratic requirements that preclude activity in accordance with 'market forces'. This in turn renders the idea of local 'advice' to purchase considerably more complex than the associated political rhetoric intimates.     

Smoking and the new health education in Britain 1950s-1970s

Advertising has a dual function for British public health. Control or prohibition of mass advertising detrimental to health is a central objective for public health in Britain. Use of mass advertising has also been a more general public health strategy, such as during the initial government responses to HIV/AIDS in the 1980s.We trace the initial significance of mass advertising in public health in Britain in the postwar decades up to the 1970s, identifying smoking as the key issue that helped to define this new approach. This approach drew from road safety and drink driving models, US advertising theory, relocation of health education within the central government, the arrival of mass consumption, and the rise of the "new public health" agenda.     

Government spending on health care: a cross-national study of public attitudes

The economic constraints of the last decade have led western industrialized nations to consider, if not actually adopt, more stringent controls over costly social policies such as health care. Using recent, nationally representative data from the United States, Great Britain, West Germany, Italy and Australia, this paper provides an international comparison of attitudes towards government spending on health care. Attitudes are found to differ by country, with Great Britain being most supportive of increased spending and West Germany and the United States most opposed. Multiple regression techniques are used to determine significant socio-demographic and political ideological factors in relation to predicting attitudes towards government spending. In many countries, those who often bear the heavier tax burden, for example, the middle classes and those with higher status jobs, were consistently more likely to oppose an increase in government spending on health; compared with them, women were found to be more supportive of such action. Measures of political ideology were found to be quite consistent and strong predictors of attitudes--political conservatism and more negative attitudes towards government generally were inversely related to support for government increases in health spending. The policy implications of these findings are discussed in the conclusion.     

阜南县乡镇卫生院合作制改造研究

通过对阜南县乡镇卫生院合作制改造的基本做法和改制后的工作效率、服务费用、服务质量等相关指标的研究，得出了实行合作制可以提高工作效率、改善服务质量及合作制并不一定必然导致过度医疗的结论；分析了合作制在筹集发展资金、优化产权结构、转换运行机制、改革管理体制等方面的作用；提出了合作制应成为卫生院产权制度改革的主要形式、合作制改造必须与管理模式改革及运行机制优化相结合、政府应加强对合作制卫生院的调控等建议。